The purpose of this letter is to remind physicians about the possible consequences of an activity as common and seemingly inoffensive as a visit to the hairdresser.
Although evidence supporting "beauty parlor stroke syndrome" has been reported,' the accounts have not resulted in any appreciable increase in public awareness. More importantly, preventive measures are not being undertaken. I reached this conclusion after extensive interviewing of physicians, older women, and individuals in the hair care industry.
My singular interest in this matter was piqued by my elderly mother's brain stem stroke a few months ago. She suffered sudden onset of dysarthria and dysphagia associated with minimal right-sided impairment of the extremities. Coincidentally, I learned that she had had her hair washed and set the day before. Upon further questioning, I also learned that her head was bent severely backwards during hair washing.
My mother's blood flow studies revealed blockage of the right vertebral artery, and MRIs suggested lacunar lesions in the brain stem. Most studies discussing vertebrobasilar artery pathogenesis support the belief that impairment or even stoppage of blood flow in the vertebrobasilar system can occur as a result of cervical spine extension accompanied by rotation or even by rotation alone. 2,3
Although most reported cases resulted from cervical spine manipulations '4-6 other causal factors have been mentioned, including sports injuries,7-8 overhead painting, prolonged overhead gazing, gymnastic and calisthenic maneuvers, and yoga. Nevertheless, a direct association with hairdresser visits was not made until Dr. Weintraub's illuminating reports. I submit my mother's stroke as an additional case of "beauty parlor stroke syndrome."
No one knows how many similar vertebrobasilar insults may have involved a prior spine manipulation. The history-taking of vertebrobasilar disease seldom includes questions about cervical spine manipulations and certainly would never include the history of a visit to the hairdresser. These admonitions apply to anyone with possibly vulnerable vertebrobasilar vasculature, including the elderly visiting the hairdresser.
Joseph S. Stratigos, MD Niles,MI
2. Krueger BR, Ozaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980; 55:322-32.
3. Weintraub MI. Beauty parlor stroke syndrome: Report of five cases. JAMA 1493; 269:2085-6.
4. Fast A, Zinicola, DF, Morin EL. Vertebral artery damage complicating cervical manipulation. Spine 1987; 12:840-2.
5. Schellhas KP, Latchaw LR, Wendling LR, Gold LH. Vertebrobasilar injuries following cervical manipulation. JAMA 1980; 244:1450-3.
6. Katirji MB, Reinmuth OM, Latchaw RE. Stroke due to vertebral artery injury. Arch Neurol 1985; 42:242-8.
7.Weinstein SM, Cantu RC. Cerebral stroke in a semi-pro football player. Med Sci Sports Exerc 1991; 23:119-21.
8. Haldeman S. Spinal manipulative ther apy i I n sports medicine. Clin Sports Med 1986; 5:277-93.